HomeMy WebLinkAboutX2021-3387 - Permit ApplicationPrint Form -j Worksheet for Combo Building & Solar Permit Application
F-, Comm'I rKResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address
Description of Work
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New/Add SF�
OWNER'S NAME
Owner's Address
Flood [i Fire Liq Landslide
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[N/A Floor Suite No
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Use Const Type
# Stories # Units (if Res)'
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Remodel SF � Garage/New/Add Muaterti/lM/
Last
First
Owner's E-mail Address
231
City State —, Zip q � Telephone_ i�•r O � � �•�G� � � P
APPLICANT'S NAME Last
Applicant's Address
City (gyp7tdc � - State J,
First
Applicant's E-mail Address
Zip QC� `�j fj� Telephone (?e�q_
ARCHITECT/DESIGNER'S NAME
Last j First _ Lic. No.
Architect/Designer's Address
cit
y (�D� G� State
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Architect/Designees E-mail Address
Zip C?LS Oj Telephone (�j—? z-gq,2 1
ENGINEER'S NAME Last j SL_� First �� Lic. No. G'�Jd�
Engineer's Address
City _�T �; - State Fj""``. _
Engineer's E-mail Address
Zip Telephone y/,�_-n�
CONTRACTOR'S NAME/COMPANY J Lic No. ��Jrl� Class
-
Contractor's Address
City -- - �Q r- ---- - State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address %3 TO b66 %7a-D-
Zip �f5/o� Telephone _7/�t-7-?(; 2,0/ Lf 7
PERMIT NO. X '�U `' I 5, g '
PLAN CHECK NO,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $